The Thrombosis in Myocardial Infarction Trial 3 (TIMI
3)
Objectives:
Investigate the role of a thrombotic agent added to
conventional medical therapies and to compare an early invasive management
strategy to a more conservative early strategy in patients with unstable angina
and non-Q wave myocardial infarction.
Background:
The myocardial ischemic syndromes, which account for a
large portion of the annual mortality and morbidity from all causes in
industrialized countries, encompass a wide clinical-pathologic spectrum. At one
end of this spectrum are patients with chronic stable angina. When studied by
coronary arteriography, such patients usually have obstructive atherosclerotic
disease with no evidence of fresh thrombosis. At the other end of the spectrum
are patients with acute MI who present with a discreet episode of prolonged
chest pain accompanied by persistent ST segment elevation. Such patients have a
high incidence of thrombotic coronary artery occlusion, and the early
intravenous administration of thrombolytic agents has been shown to reestablish
perfusion, limit the extent of left ventricular dysfunction, and reduce both
early (in-hospital) and late (1-year) mortality in this group.
Subjects:
1,473 men and women enrolled through 25 participating
centers. Ages ranged from 21 to 79 years; however, patients 75 to 79 years old
were eligible for only a brief period during enrollment. Patients were required
to have chest discomfort at rest suggestive of myocardial ischemia, lasting
greater than 5 minutes but less than 6 hours, that occured within 24 hours of
the time of enrollment.
Conclusions:
In a large study of unstable angina and non-Q wave
myocardial infarction, the incidence of death and non-fatal infarction or
reinfarction was low but not trivial after one year. An early invasive
mangement strategy was associated with slightly more coronary angioplast
procedures but equivalent numbers of bypass surgery procedures than a more
conservative early srategy of catherization and revascularizatioin only for
signs of recurrent ischemia. The incidence of death or non-fatal infarction, or
both, did not differ after one year by strategy assignment, but fewer patients
in the early invasive strategy group underwent later repeat hospital admission.
Either strategy is appropriate for patient management; differences in hospital
admissions and revascularization procedures, with their attendant costs, are
likely to be minimal.
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Study Website |
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Study Documentation |
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Data Distribution Agreement |
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